Do not press on the plunger of the syringe. Advise patients to seek prompt medical care in the event of a sudden loss of hearing or decrease while taking sildenafil. This similarity protects cGMP from degradation because sildenafil can bind to the catalytic site to act as a competitive inhibitor of cGMP-specific PDE-5, the enzyme that normally catalyzes the breakdown of vasodilatory cGMP. This medicine can cause serious side effects in patients with heart problems. Pediatric Patients: Increased mortality with increasing sildenafil dose was observed in a clinical trial of pediatric patients with PAH. During the review of systems, assessment for visual changes is recommended.Viagra comes as an oral tablet in different dosages. Discuss with your doctor what’s an appropriate dose for you. For daily use, Goldstein said, the generic form, sildenafil, comes in mg tablets. FREE – $9. After your deductible has been satisfied, you will enter the Post-Deductible (also called Initial Coverage) stage, where you pay your copay and your plan covers the rest of the drug cost. Want an exact price for your co-pay? .  · For example, a year-old might start at a dose of 50 milligrams (mg), while a year-old might have a starting dose of 25 mg. This is because, in older people, the body clears Viagra from your.